Joiner, Irma NEW YORK STATE DEPARTMENT OF HEALTH '- t)
Vital Records Section Burial - Transit Permit
s ` Name First Middle Last Sex
j
u<#.
, Irma Marie Joiner Female
Date of Death Age If Veteran of U.S. Armed Forces,
,l'= 09/08/2018 87 Years War or Dates
Place of Death Hospital, Institution or
ay City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
Manner of Death ;LIJ Natural Cause ❑Accident EI Homicide Ej Suicide 0 Undetermined El❑Pending
Circumstances Investigation
Medical Certifier Name Title
Thomas Kandora MD
s17 Address
/ 319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward 5755 51
0 Burial Date Cemetery or Crematory
09/11/2018 Pine View Crematory
['Entombment Address
®Cremation Queensbury Town, New York
40 Date Place Removed
❑Removal and/or Held
and/or
Address
Hold
z: Date Point of
Q Transportation Shipment
by Common Destination
' Carrier
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home - 01130
,, Address
e, 11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Y+ Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/11/2018 Registrar of Vital Statistics Aimee Mahoney(Efectronica1CySigned)
(signature)
24 District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 9 In 13 Place of Disposition ?mV,,, 444
(address)
•
(section) (lit number) (grave number)
Name of Sexton or Person in Charge of Premises `fd: .r SOS, tr
ii
Ar
(pleas print)Signature Title Offif ibt
(over)
DOH-1555 (02/2004)